COMMON BILIARY-PANCREATIC CONDUIT STENOSIS INDUCES PANCREOBILIARY REFLUX

A striking pancreatic juice reflux toward the biliary tree (PR) has fr equently been found in subjects with common bile-pancreatic conduit (C BPC) and gallstone-induced acute pancreatitis (SAP). Our aim was to de termine the role of the CBPC functional diameter as a potential trigge r of PR. The CBPC was calibrated in three groups of patients: (A) pati ents with gallbladder stones using intraoperative direct cholangiometr y in = 24). (B) patients after surgical removal of common bile duct st ones using postoperative cholangiometry via T-drain (n = 6), and (C) p atients with SAP using the same procedures as in group B (n = 6). In a il patients in groups B and C, aliquots of bile were collected and ass ayed for pancreatic amylase content. The mean functional diameter of t he CBPC varied from 0.80 mm in patients in groups A and B to 0.47 mm i n group C (p < 0.001). The bile samples of group B contained low conce ntrations of amylase, whereas high values could be found in all sample s of group C. Wt conclude that PR is a frequent event occurring after bile duct revision concerning small amounts of pancreatic juice, Howev er, CBPC functional stenosis as seen in patients with SAP obviously in duces PR with high amounts of pancreatic juice.